Article Text

Original research
Association between statin use and outcomes in patients with coronavirus disease 2019 (COVID-19): a nationwide cohort study
  1. Jawad Haider Butt1,
  2. Thomas Alexander Gerds2,3,
  3. Morten Schou4,
  4. Kristian Kragholm5,
  5. Matthew Phelps2,
  6. Eva Havers-Borgersen1,
  7. Adelina Yafasova1,
  8. Gunnar Hilmar Gislason2,6,
  9. Christian Torp-Pedersen7,
  10. Lars Køber1,
  11. Emil Loldrup Fosbøl1
  1. 1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2The Danish Heart Foundation, Copenhagen, Denmark
  3. 3Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark
  5. 5Departments of Cardiology, North Denmark Regional Hospital and Aalborg University Hospital, Aalborg, Denmark
  6. 6Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
  7. 7Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
  1. Correspondence to Dr Jawad Haider Butt; jawad_butt91{at}hotmail.com

Abstract

Objective To investigate the association between recent statin exposure and risk of severe COVID-19 infection and all-cause mortality in patients with COVID-19 in Denmark.

Design and setting Observational cohort study using data from Danish nationwide registries.

Participants Patients diagnosed with COVID-19 from 22 February 2020 to 17 May 2020 were followed from date of diagnosis until outcome of interest, death or 17 May 2020.

Interventions Use of statins, defined as a redeemed drug prescription in the 6 months prior to COVID-19 diagnosis.

Primary and secondary outcome measures All-cause mortality, severe COVID-19 infection and the composite.

Results The study population comprised 4842 patients with COVID-19 (median age 54 years (25th–75th percentile, 40–72), 47.1% men), of whom 843 (17.4%) redeemed a prescription of statins. Patients with statin exposure were more often men and had a greater prevalence of comorbidities. The median follow-up was 44 days. After adjustment for age, sex, ethnicity, socioeconomic status and comorbidities, statin exposure was not associated with a significantly different risk of mortality (HR 0.96 (95% CI 0.78 to 1.18); 30-day standardised absolute risk (SAR), 9.8% (8.7% to 11.0%) vs 9.5% (8.2% to 10.8%); SAR difference, −0.4% (−1.9% to 1.2%)), severe COVID-19 infection (HR 1.16 (95% CI 0.95 to 1.41); 30-day SAR, 13.0% (11.8% to 14.2%) vs 14.9% (12.8% to 17.1%); SAR difference, 1.9% (−0.7% to 4.5%)), and the composite outcome of all-cause mortality or severe COVID-19 infection (HR 1.05 (95% CI 0.89 to 1.23); 30-day SAR, 17.6% (16.4% to 18.8%) vs 18.2% (16.4% to 20.1%); SAR difference, 0.6% (−1.6% to 2.9%)). The results were consistent across subgroups of age, sex and presumed indication for statin therapy. Among patients with statin exposure, there was no difference between statin drug or treatment intensity with respect to outcomes.

Conclusions Recent statin exposure in patients with COVID-19 infection was not associated with an increased or decreased risk of all-cause mortality or severe infection.

  • COVID-19
  • epidemiology
  • cardiology
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JHB and ELF had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JHB, ELF, LK. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: JHB. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: JHB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval In Denmark registry-based studies that are conducted for the sole purpose of statistics and scientific research do not require ethical approval or informed consent by law. However, the study is approved by the data responsible institute (Capital Region of Denmark, approval number: P-2019-191) in accordance with the General Data Protection Regulation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data for this study are derived from Statistics Denmark. By law, these data are not allowed to be shared and therefore data cannot be made available to other researchers.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.